Provider Demographics
NPI:1144325655
Name:CREED, RICHARD DAN (OD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:DAN
Last Name:CREED
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3705 W BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-2142
Mailing Address - Country:US
Mailing Address - Phone:918-687-7530
Mailing Address - Fax:918-687-4019
Practice Address - Street 1:3705 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-2142
Practice Address - Country:US
Practice Address - Phone:918-687-7530
Practice Address - Fax:918-687-4019
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1148152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100759620 AMedicaid
OK800522041Medicare ID - Type Unspecified
OK100759620 AMedicaid